Outside Opinion: Testosterone treatments are dangerous for men

Jim Oborny, of Gurnee, in the office of Dr. Mark Rosenbloom, started on an anti-aging program a year ago. He said he feels much better and has much more energy. (Stacey Wescott, Chicago Tribune)

Hormonal anti-aging treatments have been around since 1889, when neurologist Charles-Edouard Brown-Sequard announced that injections of liquefied guinea pig and dog testicles improved his strength and health.

Today, testosterone gels and patches can be part of many men's daily routine. Testosterone manufacturers are convincing men — and the physicians who treat them — that they have "Low T" syndrome, or testosterone deficiency. Symptoms are so common and vague, it's a rare person who would avoid self-diagnosing Low T after taking the quiz at IsItLowT.com. The site is sponsored by AbbVie (formerly part of Abbott Labs), manufacturer of best-selling testosterone treatment AndroGel. If you're bored, stressed or aging normally, you probably have Low T symptoms: grumpiness, less energy, lower libido and "falling asleep after dinner."

Even if you feel fine, you may still qualify for treatment. AbbVie's other website, DriveForFive.com, describes five risks to men's health: high cholesterol, high blood pressure, high blood sugar, high PSA levels and — can you guess? — low testosterone.

But just what are low testosterone levels? No one really knows. After age 40, levels decline by about 1 to 2 percent every year. But there's a wide range of individual levels in every age group, and levels don't correlate with symptoms. Testosterone levels fluctuate hourly and are affected by factors including sleep, exercise and even whether your sports team won.

Some physicians, in the footsteps of Dr. Brown-Sequard, practice so-called anti-aging medicine. Clinics prescribe "bioidentical" testosterone, estrogen, progesterone, cortisol or thyroid hormones, then use compounding pharmacies to concoct non-FDA-approved hormone cocktails. Bioidentical hormones are synthesized versions of our own hormones, but that does not make them safer — excessive naturally occurring testosterone and estrogen can raise the risk of cancer.

Testosterone drugs are also associated with more heart attacks, blood clots and anemia, worsening heart failure, and increased prostate cancer risk. Industry-funded studies may minimize adverse events. A meta-analysis of almost 3,000 men in 27 non-industry funded studies found that testosterone doubled the risk of strokes, heart attacks and other heart problems. Studies funded by pharmaceutical companies found no increased risk.

Now it's men's turn to take drugs with proven harms and unproven benefits. A document that was disclosed in a lawsuit against Solvay, then AndroGel's owner, discussed a need to expand the testosterone market by 36.5 percent, according to a McClatchy Newspapers article. Solvay talked about pushing the drug to primary care physicians, described as "easily influenced," according to documents the article cited.

Testosterone is a reasonable treatment in men with missing or damaged testicles. But if you've got normal cojones, don't risk taking potent hormones. The latest fountain of youth may turn out to be a cesspool.

Dubowitz is project manager and Fugh-Berman is director of PharmedOut, a Georgetown University Medical Center project that advocates evidence-based prescribing.